PROBLEM 70-year-old female long-term-care resident with diabetes, immobility, incontinence of bowel and bladder and osteomyelitis readmitted following a hospital stay with one month history of multiple stage II (avascular) and unstageable (100% yellow slough) pressure ulcers of sacrum/coccyx with severe erythema, multiple scratches on buttocks. Largest wounds: R:3.0cmx2.5cmx0.6cm deep, L:2.0cmx0.6cmx0.1cm deep, draining moderate amounts sanguineous and purulent light yellow exudate. Total lymphocytes 1300, albumin 2.2, Norton scale 5. Mentation deteriorated during hospitalization – now tube-fed and non-compliant. Apparent pain during treatment. Returned to long-term-care facility: wounds treated with balsam Peru/castor oil/trypsin ointment seven days, then a standard foam dressing 21 days, all with no improvement. On oral antibiotics, repositioned every two hours, on pressure-air-flow redistribution surface.

RATIONALE Polymeric membrane dressings reduce wound pain and inhibit infection while donating or absorbing moisture as needed. Ingredients draw and concentrate healing substances from the body into wound bed to promote rapid healing while facilitating autolytic debridement directly by loosening bonds between slough and wound bed. Liquefied slough is absorbed by dressing, often eliminating need for cleansing during dressing changes. Due to patient's debilitated state and co-morbidities, infection was concern. Silver version has additional antimicrobial properties. Therefore, silver polymeric membrane dressings initiated.

METHODOLOGY After initial saline flush, silver polymeric membrane dressings applied to facilitate autolytic debridement. Dressings reinforced with cloth stretch tape. Per manufacturer, no wound cleansing done during dressing changes (every three days). Periwound skin treated with antifungal ointment.

RESULTS Case is ongoing. Significant improvement at first dressing change; after ten days, wounds were: R:2.0cmx0.8cm and L:2.1cmx0.6cm; both less than 0.1 cm deep with 70 – 75% yellow film; 25 – 30% epithelialization. Periwound skin healthy-looking. Pain decreased each dressing change.